Antidepressants may reduce the risk of intubation or death in patients hospitalized with COVID-19, according to a large observational study published in Molecular Psychiatry.
“[A]ntidepressant use, at a mean dosage of 21.6 fluoxetine-equivalent milligrams, was significantly and substantially associated with reduced risk of intubation or death, independently of patient characteristics, clinical and biological markers of disease severity, and other psychotropic medications,” wrote Nicolas Hoertel, M.D., Ph.D., M.P.H., of the University of Paris and colleagues. “These findings should be interpreted with caution due to the observational design of the study. However, our findings provide support for conducting controlled randomized clinical trials of antidepressant medications for COVID-19.”
Hoertel and colleagues looked at health data from 7,230 adults aged 18 and older who were admitted to one of the 39 Assistance Publique-Hôpitaux de Paris for COVID-19 between January 24 and April 1, 2020 (Assistance Publique-Hôpitaux de Paris is the largest hospital system in Europe). Of this group, 345 patients received an antidepressant within 48 hours of admission; this included 195 patients receiving a selective serotonin reuptake inhibitor (SSRI) and 150 patients receiving antidepressants in other classes. The patients who received antidepressants were older and sicker than the patients who did not receive antidepressants.
Overall, about 24% of COVID-19 patients who received an antidepressant and 17% who did not receive an antidepressant died or required intubation while hospitalized. After adjusting for other health factors, however, the patients taking antidepressants had a 44% reduced risk of intubation or death; SSRIs reduced the risk by 49%, while non-SSRIs reduced the risk by 35%. When the researchers conducted a smaller analysis comparing the 345 antidepressant-receiving patients with a matched group of 345 control patients, they obtained similar results. They also obtained similar results when comparing patients who received an antidepressant with those who received the sedative diazepam.
The researchers did not observe any reduced risk of death among patients who had a history of antidepressant use but did not receive an antidepressant during their hospitalization. This suggests that the reduced risk is related to acute effects of the medications.
Hoertel and colleagues noted that several antidepressants are known to have anti-inflammatory properties, which could partially explain their association with reduced death or intubation. Studies have also shown that many antidepressants can reduce the ability of viruses to invade certain cells, while some—including fluoxetine—may even have direct antiviral properties.
For more information, see the Psychiatric News article “Patients With MH Disorders Found More Susceptible to COVID-19, Death.”
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